A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature

Piraino, Javier; Chaudhray, Hira; Ames, Kyle; Okoye, Frederick; Sterling, Matthew; Clavell-Hernández, Jonathan; Levine, Laurence A.; Ziegelmann, Matthew

doi:10.1016/j.sxmr.2022.08.001

Cited by 8 publications

(1 citation statement)

References 107 publications

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“…The chronic phase (stable) of PD is characterized by a palpable plaque with a deformity that is no longer progressive [1]. To date, there are no rmly agreed upon criteria characterizing the transition to chronic PD given the broad patient presentations within the literature, but there is agreement that all patients must be in the stablephase (deformity unchanged for a minimum of 3-6 months) before surgical intervention [4,9,11].…”

Section: Introductionmentioning

confidence: 99%

(424) A Contemporary Assessment of Patients Presenting to a Tertiary Medical Center with Peyronie’s Disease

Roadman

Wang

Beer

et al. 2023

The Journal of Sexual Medicine

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Introduction Peyronie’s disease (PD) is a progressive wound-healing disorder resulting in plaque formation within the tunica albuginea. PD continues to be poorly understood and an area of investigation, with increased awareness by patients and clinicians. Most commonly, PD patients will have a singular plaque and uniplanar curvature in the dorsal or lateral direction. However, previous studies have categorized less common deformities as “atypical”, which includes ventral curvature, multiplanar curvatures, unilateral indentations, hourglass deformity, and severe loss of penile length. Objective We aim to characterize the presenting features of PD within a large cohort of patients presenting to a tertiary referral center. Furthermore, we seek to elucidate the pre-operative factors that correlate with subsequent surgical intervention. Methods 1483 consecutive patients presenting with PD from 2016 to 2021 were retrospectively identified. Patients were excluded if they only had virtual visits, refused penile duplex evaluation, or had PD surgical correction prior to presentation. Baseline demographics, prior treatments, physical exam findings, penile duplex assessment (PDDU), subsequent interventions, and clinical outcomes were documented. Univariate and multivariate analyses were performed to assess pre-operative predictors of subsequent surgical intervention. Results In total, 1263 patients met inclusion criteria. Mean age at presentation was 55.4 ± 11.1 years with a mean duration of PD at presentation of 33.2 ± 42.5 months. Mean primary curvature was 49.8 ± 20.8°. Primary ventral curvature was present in 11.4% and 36.5% of patients had a multiplanar curvature. Mean composite curvature was 60.4 ± 28.2°. Subjective penile shortening was reported by 64.8% of patients with a mean reported loss of 3.8 ± 2.1 cm. During PDDU, indentation/narrowing deformities was appreciated in 73.7%, hourglass deformity in 10.1%, and hinge effect in 33.0% of patients. Calcification was seen in 30.1% of patients. Operative intervention occurred in 35.3% of patients. Hypogonadism (1.56 OR, p=0.04), severity of primary curvature (1.03 OR, p<0.001), hourglass deformity (1.82 OR, p=0.01), decreased tunical elasticity (1.20 OR, p=0.03), and prior intralesional Xiaflex injections (2.94 OR, p <0.001) predicted subsequent surgical correction. Negative predictors of surgical intervention included use of any oral PD treatment (0.43 OR, <0.001) and ability to perform penetrative sex (0.72 OR, p=0.04). 446 (35.3%) patients underwent surgical intervention with 170 (38.1%) plaque incision/excision and grafting, 110 (24.7%) tunical plication, and 166 (37.2%) inflatable penile prosthesis cases. Conclusions Peyronie’s disease remains an incompletely understood disease and presenting features may be changing as a result of more sophisticated evaluation and physician experience. Ventral curvature, multiplanar curvatures, indentation deformity, hourglass deformity, and severe loss of penile length have been described as “atypical”, but these changes are not rare in our cohort of referred patients. Patients with worse erectile function and more severe PD characteristics were predictors of surgical intervention. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

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Section: Introductionmentioning

confidence: 99%

(424) A Contemporary Assessment of Patients Presenting to a Tertiary Medical Center with Peyronie’s Disease

Roadman

Wang

Beer

et al. 2023

The Journal of Sexual Medicine

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Non-surgical therapies for Peyronie's disease

Rosenberg

Ergun

Hwang

et al. 2023

Cochrane Database of Systematic Reviews

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Daily low-dose tadalafil may reduce the penile curvature progression rate in patients with acute Peyronie’s disease: a retrospective comparative analysis

et al. 2022

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The aim of this study was to evaluate the clinical outcomes of patients in acute phase of Peyronie's disease (PD) treated with daily low-dose of Tadala l. An observational retrospective study involving patients in acute phase of PD with erectile dysfunction (ED) was designed. All subjects were offered Tadala l 5 mg one tablet a day. Men who accepted treatment were compared to patients who refused Tadala l. Penile curvature progression was chosen as the primary outcome. PD Questionnaire (PDQ) and IIEF-5 scores were selected as secondary outcomes. A total of 191 patients were included in the study (108 intervention vs. 83 control). Penile curvature progression rate was signi cantly lower in subjects taking Tadala l at 12 weeks (25.9% vs 39.7%, p = 0.042). Mean IIEF-5 score improved in the intervention group, becoming signi cantly higher compared to the observation group at 12 weeks (19.3 vs. 11.2 points, p < 0.001). Mean PDQ-Overall and PDQ-Penile Pain scores improved in the intervention group and the statistically signi cant differences at baseline between groups became not statistically signi cant at 12 weeks (p = 0.232 and p = 0.078, respectively). Daily low-dose Tadala l in patients with acute phase of PD seems to signi cantly reduce the penile curvature progression rate compared to observation, especially when it is administrated early. It also appears to improve erectile function and PD-related symptoms.

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A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature

Cited by 8 publications

References 107 publications

(424) A Contemporary Assessment of Patients Presenting to a Tertiary Medical Center with Peyronie’s Disease

(424) A Contemporary Assessment of Patients Presenting to a Tertiary Medical Center with Peyronie’s Disease

Non-surgical therapies for Peyronie's disease

Daily low-dose tadalafil may reduce the penile curvature progression rate in patients with acute Peyronie’s disease: a retrospective comparative analysis

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